Routine inspection·August 8, 2024

On 08/08/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with house manager Elmer Carlos. LPA explained the purpose of today’s visit. Carlos contacted the administrator Antonia Dionisio who later was present during the visit. The facility is licensed to operate for (6) non-ambulatory of which (2) maybe bedridden elderly adults ages 60 and above. Currently, the facility has (1) hospice resident in care. The facility is approved for (1) hospice resident. The facility is a single-story structure located in a residential neighborhood. It consists of the following: (5) residents' rooms, (2) bathrooms, (1) staff bedroom, (1) staff bathroom, a living area, a dining area, a kitchen, and a garage used for storage. LPA toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 107.8 degrees F. A comfortable temperature of 78 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. A fire extinguisher was charged. The facility has conducted emergency fire drills on a month basis. The last Fire Drill was on 07/05/24 10:40 am. A review of the Medication Administration Record (MAR) was observed to be maintained in order. (Evaluation Report continues LIC 809-C) LPA observed First Aid Kit was maintained. A working landline phone was operational. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 09/23/23 through 09/23/24. The facility has CCLD license annual due on 08/11/24. An audit of residents #1-#4 (R1-R4) service files and staff #1-#4 (S1-S4) personnel files. The facility has the current administrator's certification on file for Antonia Dionisio #6033374740 Expiration 12/11/2024. DEFICIENCIES: Resident #2 who was admitted in June 2023 had missing needs/services appraisal and incomplete CCLD forms fill out completely. Observation of window screen for room #5 has a hole and will need to repair/replace. Observation of no shower curtain in resident's bathroom for privacy. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D). An exit interview conducted with Antonia Dionisio a copy of report and appeal rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *